DESCRIPTION: American Indians have been characterized as having high rates of Fetal Alcohol Syndrome (FAS). There is, however, substantial variation in FAS rates among Indian communities and tribes. This research is a multi-site prevention trial which will measure the effectiveness of a comprehensive, public health model, reservation/community-wide FAS prevention program as defined by the recent Institute of Medicine (IOM) report on FAS. It will utilize a control and pre/post measures design to assess indicated, selected, and universal prevention techniques applied by four American Indian communities which are representative of other tribal communities. Prevention sites will be matched to and compared extensively with two control communities. Utilizing specific techniques of research and prevention rigorously applied by the proposed investigators at various times in American Indian communities over the past seventeen years, this study will determine whether comprehensive community-wide prevention of FAS is effective, to what extent, and which specific aspects of prevention are most viable. This proposal builds on an existing NIAAA pre-prevention research grant currently measuring the epidemiologic characteristics of FAS, adult drinking characteristics, and maternal alcohol abuse risk factors among the same four Indian communities proposed here as the prevention sites in this proposal. The specific aims of this research are: to implement the IOM comprehensive FAS prevention program; to measure the effectiveness of comprehensive FAS prevention through formative evaluation of specific prevention components and change in age-specific FAS prevalence rates and specific secondary (proxy) measures in six American Indian communities (4 prevention and 2 control); to measure change in adult drinking and associated risk factors (KABB) over time; to determine the overall effect of comprehensive FAS prevention over control sites, and to further delineate and define maternal risk factors for FAS. The preventive interventions will be implemented by 2.5 FTE personnel at each of the 4 prevention sites and the university-based researchers. In indicated prevention, research-defined maternal risk behaviors will be changed via case detection and case management of high risk individuals; brief interventions using the principles of community reinforcement approach (CRA) and motivational enhancement therapy (MET); and individual empowerment and skills building. In selected and universal prevention, routine screening for risk of alcohol abuse, targeted messages of health education to specific aggregates for change in knowledge, attitudes, beliefs, and norms, and policy advocacy and community motivation will be used. Results will be specifically applicable to most American Indican and Alaska Native communities. Furthermore, prevention protocols, research techniques and methods, will test the recommendations of the IOM report and should also be applicable to non-Indian communities as well.